IUDs Are 20 Times As Effective as the Pill, So Why Aren't More Women Using Them?

The intrauterine device, or IUD, is the most effective form of reversible birth control available to women. New research shows that when the small, T-shaped device is inserted into a woman's uterus to deter sperm from reaching an egg, it's 20 times better at preventing pregnancy than the birth control pill, the hormonal patch, or the vaginal ring. Condom failure rates are even worse. In one study, 75 percent of women said they'd prefer an IUD to alternate forms of contraception. Still, only 5 percent of women actually use them.

IUDs could be instrumental in improving one of America's most dismal reproductive stats: 50 percent of pregnancies in the United States—3 million a year—are unplanned. Half are a result of contraceptive failure. So why aren't women using the best and most desirable pregnancy prevention tool on the market?

It's partly an issue of cost. IUD insertion cancost hundreds of dollars. That initial investment can last between five and 10 years, but many women can't front the cash—in the study, 75 percent of women chose the IUD over other forms of birth control when all contraceptive options were offered free of cost. Our health care system sacrifices long-term benefits for short-term economics, too: Instead of footing the bill for an extremely effective form of birth control now, we're paying for millions of unplanned pregnancies down the road.

But even women who can afford the IUD are often deterred or outright denied access. Until recently, the FDA only approved IUDs for use in women with children, citing "risks of permanent infertility"—in rare cases, an IUD can puncture the uterus upon insertion, or increase a woman's risk of complicating an otherwise harmless STI. But there's some evidence that the infertility risk is overstated. One 2007 study found that even among women who engage in "high-risk" sexual behavior and had a history of STDs, the IUDs on the market today "do not increase the rate of pelvic inflammatory disease or infertility among women." In fact, Mirena—a hormonal IUD that hit the market in 2001—could actually help "protect against STDs by causing an overproduction of cervical mucus," a natural barrier to infection.

Today, the FDA still only recommends Mirena for women who have children, and doctors still work to deter childless women from choosing an IUD. When one friend approached her gynecologist about switching to an IUD, the doctor told her that she had a personal policy against prescribing the method to women not in monogamous relationships—even though my friend reported that she understood the risks, has never contracted an STD, and always uses condoms. The implication is that some women are allowed to make their own choices about their reproductive health, and some aren't—and only women who already have kids are allowed to risk never having any more.

Of course, IUDs aren't for everyone. When the IUD was approved for childless women in 2005, usage rates jumped 160 percent. But the study found that women who choose IUDs still tend to be "older, to have public health insurance, and to have more children," while the pill, the patch, and the ring remain more popular among women who have private health insurance and no kids. That leaves the IUD too expensive for the women who want it most and its use discouraged among the women who can actually afford it—and U.S. unplanned pregnancy rates some of the highest in the developing world.